This Mentored Patient-Oriented RCDA is a resubmission, designed to enhance clinical training and research expertise in the area of psychiatric disorders during pregnancy and the postpartum period. The research aim of this proposal includes a study to evaluate risk for recurrence among pregnant bipolar women. Following-up preliminary findings, morbid risk will be compared quantitatively in women who continue or discontinue mood-stabilizers; recurrence of a first new episode of DSM-IV mania or bipolar depression and its timing from initial assessment are primary outcome measures. Secondary considerations include analyses of associated clinical (demographic, social, prior morbidity) and pharmacological (drug-type, duration of use, mean dose and serum concentration, and rate of discontinuation) predictors of recurrence, as well as the neonatal outcome of infants born to the subjects. The design involves open and clinical, but prospective, single blind, longitudinal follow-up of parallel groups of women with DSM-IV bipolar disorders who become pregnant and continue vs. discontinue mood-stabilizing medications. The proposal also includes a rich training component. Close supervision is provided by Massachusetts General Hospital co-mentors Lee S. Cohen, M.D. and Ross J. Baldessarini, M.D., with frequent consultation with local and national experts in mood disorders and psychopharmacology research, perinatal psychiatry, obstetrics, reproductive endocrinology, teratology, research ethics, and formal coursework in statistics and research design aimed at satisfying requirements for the MPH degree at Harvard School of Public Health. The awardee is thus assured a critical fund of basic knowledge and practical research experience with clinical, qualitative and quantitative methods required for her research career in women's mental health in pregnancy and the postpartum period--a remarkably underdeveloped area of major clinical and public health significance.